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Israel Pena, Erin Y Chew, Barcleigh P Landau, Joseph T Breen, Jose P Zevallos, Jeffrey T Vrabec
OBJECTIVE: To investigate the prevalence of vestibular schwannoma (VS) and asymmetric sensorineural hearing loss in the Veterans Administration hospital population and analyze a more efficient method of diagnosing VS in a population with significant noise exposure. STUDY DESIGN: Retrospective review of South Central (VISN 16) Veterans Administration hospitals. METHODS: Record query for ICD-9 codes for asymmetric sensorineural hearing loss or VS between 1999 and 2012...
October 14, 2016: Otology & Neurotology
Raya Elfadel Kheirbek, Janusz Wojtusiak, Sorina O Vlaicu, Farrokh Alemi
BACKGROUND: Heart failure is the leading cause for 30-day all-cause readmission. Although racial disparities in health care are well documented, their impact on 30-day all-cause readmission rate is inconclusive. OBJECTIVE: We examined the impact of racial disparity on 30-day readmission for hospitalized patients with heart failure. METHODS: This is a retrospective secondary data analysis for a large veteran cohort in 130 Veterans Affairs Medical Centers...
October 2016: Quality Management in Health Care
Derenda Lovelace, Diane Hancock, Sabrina S Hughes, Phyllis R Wyche, Claire Jenkins, Cindy Logan
BACKGROUND: In 2011, the Hunter Holmes McGuire Veterans Administration Medical Center (VAMC) in Richmond, VA, had a cumulative readmission rate and emergency department (ED) revisits for discharged Veterans of 1 in 5. In 2012, a transitional care program (TCP) was implemented to improve care coordination and outcomes among Veterans, with an emphasis on geriatric patients with chronic disease. This TCP was created with an interdisciplinary approach using intensive case management interventions, with a goal of reducing Veteran ED and hospital revisits by 30%...
November 2016: Professional Case Management
Carlo Banfi, Matteo Pozzi, Marie-Eve Brunner, Fabio Rigamonti, Nicolas Murith, Damiano Mugnai, Jean-Francois Obadia, Karim Bendjelid, Raphaël Giraud
Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has known a widespread application over the last decade and is now an effective and valuable therapeutic option in refractory cardiogenic shock of various etiologies. In this subgroup of critically ill and unstable patients in cardiogenic shock, VA-ECMO allows, on the one hand, temporary hemodynamic stabilization with improvement of end-organ function and, on the other hand, gives the time to perform complementary diagnostic exams and to decide the therapeutic strategy in these high-risk candidates for immediate long-term mechanical circulatory support (MCS) implantation...
September 2016: Journal of Thoracic Disease
Morgan C Shields, Meredith B Rosenthal
OBJECTIVE: Little is known about the quality of inpatient psychiatric care. This study examined associations between performance on seven measures of inpatient psychiatric quality and hospital ownership. METHODS: The study design was a cross-sectional analysis of The Joint Commission's 2014 inpatient psychiatric hospital quality measures. The measures evaluate admission screening for violence risk, substance use, psychological trauma history, and patient strengths; use of seclusion and restraint; the practice of discharging patients on multiple antipsychotics; providing appropriate justification when patients are discharged on multiple antipsychotics; creation of continuing care plans; and transmission of care plans to the next level of care...
October 17, 2016: Psychiatric Services: a Journal of the American Psychiatric Association
Perica Davitkov, Apoorva Krishna Chandar, Amy Hirsch, Anita Compan, Marina G Silveira, Donald D Anthony, Suzanne Smith, Clare Gideon, Robert A Bonomo, Yngve Falck-Ytter
BACKGROUND: Clinicians often face dilemmas with decisions related to formulary choices when two similar drugs are simultaneously available in the market. We studied the comparative safety, effectiveness, and treatment costs of the two first generation direct-acting antiviral agents (DAA), boceprevir and telaprevir as uncertainty existed regarding the drug of choice between these two seemingly equally Hepatitis-C treatment options. METHODS: We randomly assigned 50 patients in an open-label, pragmatic randomized controlled trial (RCT) at a VA Medical Center to either boceprevir or telaprevir in combination with peginterferon and ribavirin, stratified by the presence of cirrhosis and prior treatment experience...
2016: PloS One
Gail D E Maconachie, Shegufta Farooq, Glen Bush, Julie Kempton, Frank A Proudlock, Irene Gottlob
Importance: Occlusion dose monitors have helped establish that better adherence to occlusion is associated with improved visual outcomes in patients undergoing amblyopia treatment. However, the role of adherence to glasses wearing is unknown. Objectives: To establish the feasibility and reliability of objectively monitoring adherence to glasses wearing using age-based norms, establish the association between adherence to glasses wearing and improvement in visual acuity (VA) after optical treatment and occlusion therapy, and analyze the effect of age, sex, refractive errors, type of amblyopia, and adherence to glasses wearing on improvement in VA...
October 13, 2016: JAMA Ophthalmology
Brandon Battis, Linda Clifford, Mostaqul Huq, Edrick Pejoro, Scott Mambourg
OBJECTIVES: Patients treated with oral chemotherapy appear to have less contact with the treating providers. As a result, safety, adherence, medication therapy monitoring, and timely follow-up may be compromised. The trend of treating cancer with oral chemotherapy agents is on the rise. However, standard clinical guidance is still lacking for prescribing, monitoring, patient education, and follow-up of patients on oral chemotherapy across the healthcare settings. The purpose of this project is to establish an oral chemotherapy monitoring clinic, to create drug and lab specific provider order sets for prescribing and lab monitoring, and ultimately to ensure safe and effective treatment of the veterans we serve...
October 12, 2016: Journal of Oncology Pharmacy Practice
Corey J Medler, J Aubrey Waddell, Dominic A Solimando
The complexity of cancer chemotherapy requires pharmacists be familiar with the complicated regimens and highly toxic agents used. This column reviews various issues related to preparation, dispensing, and administration of antineoplastic therapy, and the agents, both commercially available and investigational, used to treat malignant diseases. Questions or suggestions for topics should be addressed to Dominic A. Solimando, Jr, President, Oncology Pharmacy Services, Inc., 4201 Wilson Blvd #110-545, Arlington, VA 22203, e-mail: OncRxSvc@comcast...
November 2015: Hospital Pharmacy
Varun Victor L, Sreejith Paul Va, Betsy Mathew
No abstract text is available yet for this article.
January 2016: Journal of the Association of Physicians of India
Winai Chaidaroon, Sumet Supalaset
PURPOSE: To describe corneal ring infiltrates caused by Serratia marcescens in a patient with human immunodeficiency virus (HIV-1) who wore contact lenses. METHODS: A case study of a patient with keratitis due to an infection caused by S. marcescens and exhibiting corneal ring infiltrates was reviewed for history, clinical manifestation, microscopic study, and management. RESULTS: A 29-year-old man who had a history of contact lens wear and HIV-1 infection was admitted to hospital because of blurred vision, redness, and corneal infiltrates in the shape of a ring in the left eye...
May 2016: Case Reports in Ophthalmology
Cécile Aubron, Joris DePuydt, François Belon, Michael Bailey, Matthieu Schmidt, Jayne Sheldrake, Deirdre Murphy, Carlos Scheinkestel, D Jamie Cooper, Gilles Capellier, Vincent Pellegrino, David Pilcher, Zoe McQuilten
BACKGROUND: Bleeding is the most frequent complication associated with extracorporeal membrane oxygenation (ECMO) support in critically ill patients. Nonetheless, risk factors for bleeding have been poorly described especially those associated with coagulation anomalies and anticoagulant therapy during ECMO support. The aim of this study is to describe bleeding complications in critically ill patients undergoing ECMO and to identify risk factors for bleeding events. METHODS: We retrospectively analysed ICU charts of adults who received either veno-venous (VV) or veno-arterial (VA) ECMO support in two participating ICUs between 2010 and 2013...
December 2016: Annals of Intensive Care
Federico Pappalardo, Christian Schulte, Marina Pieri, Benedikt Schrage, Rachele Contri, Gerold Soeffker, Teresa Greco, Rosalba Lembo, Kai Müllerleile, Antonio Colombo, Karsten Sydow, Michele De Bonis, Florian Wagner, Hermann Reichenspurner, Stefan Blankenberg, Alberto Zangrillo, Dirk Westermann
AIMS: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support stabilizes patients with cardiogenic shock. Despite improved oxygenation and peripheral circulation, LV unloading may be impeded due to the increased afterload, resulting in a failing static left ventricle and in high mortality. METHODS AND RESULTS: We describe for the first time a large series of patients treated with the combination of VA-ECMO and Impella(®) compared with patients with VA-ECMO only...
October 6, 2016: European Journal of Heart Failure
Nicolas Majunke, Norman Mangner, Axel Linke, Enno Boudriot, Sandra Erbs, Franziska Tietz, Sabrina Wolff, Stephan Schürer, Gerhard Schuler, Marcus Sandri
OBJECTIVE: Surgical femoral cutdown for decannulation after veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is considered standard practice. However, access-site complications with this technique are not rare. The objective of this study is to evaluate feasibility, safety, and efficacy of a complete percutaneous decannulation procedure after VA-ECMO compared with the conventional surgical cutdown approach. METHODS: In 35 patients who were successfully weaned from VA-ECMO support, femoral artery and vein access sites were closed using a completely percutaneous approach in 15 patients, whereas 20 patients had conventional surgical cutdown for access-site closure...
October 2016: Journal of Invasive Cardiology
Shereen Katrak, Lawrence P Park, Christopher Woods, Andrew Muir, Charles Hicks, Susanna Naggie
Background.  Hepatitis C virus (HCV) infection is a leading cause of cirrhosis and the primary cause of liver transplantation in the United States, and coinfection with human immunodeficiency virus (HIV) increases the risk of comorbidities. However, healthcare utilization (HCU) patterns among HIV/HCV-coinfected patients are poorly understood. This study compared the rates of HCU and reasons for hospital admission among HCV-infected, HIV-infected, and HIV/HCV-coinfected veterans. Methods.  Hepatitis C virus- and HIV-infected and HIV/HCV-coinfected veterans in care with the Department of Veterans Affairs (VA) from 1998 to 2009 (n = 335 371, n = 28 179, n = 13 471, respectively) were identified by HIV- and HCV-associated International Classification of Diseases, Ninth Revision codes from the clinical case registry...
September 2016: Open Forum Infectious Diseases
Zeyu Lv, Yuting Wang, Ting Yang, Xue Zhan, Zhongyue Li, Huajian Hu, Tingyu Li, Jie Chen
To investigate whether gut microbiota is associated with vitamin A nutritional levels in children with persistent diarrhea, a total of 59 pediatric patients with persistent diarrhea aged 1-12 months were selected from the Department of Gastroenterology at the Children's Hospital of Chongqing Medical University, China. Subjects were hospitalized and divided into VA-deficient (n = 30) and VA-normal (n = 29) groups according to their venous serum retinol levels. Fecal samples from all 59 subjects were collected immediately after admission and analyzed by Illumina MiSeq for 16S rRNA genes to characterize the overall microbiota of the samples...
September 2016: Journal of Clinical Biochemistry and Nutrition
Erin Damery, Dominic A Solimando, J Aubrey Waddell
The complexity of cancer chemotherapy requires pharmacists be familiar with the complicated regimens and highly toxic agents used. This column reviews various issues related to preparation, dispensing, and administration of antineoplastic therapy, and the agents, both commercially available and investigational, used to treat malignant diseases. Questions or suggestions for topics should be addressed to Dominic A. Solimando, Jr., President, Oncology Pharmacy Services, Inc., 4201 Wilson Blvd #110-545, Arlington, VA 22203, e-mail: OncRxSvc@comcast...
September 2016: Hospital Pharmacy
Pascale Schwab, Harlan Sayles, Debra Bergman, Grant W Cannon, Kaleb Michaud, Ted R Mikuls, Jennifer Barton
OBJECTIVES: Many veterans enrolled in Veterans Affairs (VA) also receive care through other healthcare systems. Both VA and non-VA healthcare use must therefore be considered when conducting research in this population. This study characterized dual care utilization in veterans with rheumatoid arthritis (RA) and explored associations with RA disease activity. METHODS: Through a questionnaire mailed to RA patients at three VA sites, veterans reported medical services by non-VA primary care and subspecialty providers, comorbidities, non-VA medications, and hospitalizations...
October 1, 2016: Arthritis Care & Research
Eiji Hirakawa, Satoshi Ibara, Takuya Tokuhisa, Yoshinobu Maede, Takako Kuwahara, Chie Ishihara, Hiroyuki Noguchi, Yoshiki Naitou, Masakatsu Yamamoto, Masaya Kibe, Tsuyoshi Yamamoto, Tomonori Kurimoto, Masato Kamitomo, Kazutoshi Cho, Hisanori Minakami
BACKGROUND: There have been few reports regarding outcomes after extracorporeal membrane oxygenation (ECMO) in newborn Japanese infants. METHODS: A review of 61 neonates with ECMO through January 1995 at a single center was performed. ECMO was used in neonates with oxygenation index > 20 after conventional treatments. Background factors, such as etiology, vascular access mode (veno-venous [VV] or veno-arterial [VA]), number of days with ECMO, and early ECMO (within 24 hours after birth), were analyzed in relation to outcome with respect to survival to hospital discharge (SHD)...
October 3, 2016: Pediatrics International: Official Journal of the Japan Pediatric Society
Anne E Sales, Mary Ersek, Orna K Intrator, Cari Levy, Joan G Carpenter, Robert Hogikyan, Helen C Kales, Zach Landis-Lewis, Tobie Olsan, Susan C Miller, Marcos Montagnini, Vyjeyanthi S Periyakoil, Sheri Reder
BACKGROUND: The program "Implementing Goals of Care Conversations with Veterans in VA LTC Settings" is proposed in partnership with the US Veterans Health Administration (VA) National Center for Ethics in Health Care and the Geriatrics and Extended Care Program Offices, together with the VA Office of Nursing Services. The three projects in this program are designed to support a new system-wide mandate requiring providers to conduct and systematically record conversations with veterans about their preferences for care, particularly life-sustaining treatments...
September 29, 2016: Implementation Science: IS
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